Stress management and exercise training in chronic stable angina pectoris

Abstract

Patients suffering from chronic stable angina pectoris were allocated to one of four conditions: stress management training, exercise training, combined stress management and exercise, or waiting list control. Patients undertook an exercise tolerance test before and after intervention, and at follow-up assessment eight weeks later. They also kept a daily diary of the frequency, duration and intensity of all angina episodes, and recorded the amount of medication taken, for the week preceding and the week following intervention, as well as for the eighth week of follow-up. Patients who undertook the combined stress management and exercise programme faired best. They showed sustained gains in achieved workload on the exercise tolerance test at no cost in terms of ischaemia, as measured by ST-segment depression. They also registered less frequent angina attacks following intervention than the exercise only and waiting list control patients, and reported reduced reliance on medication; the latter benefit was sustained at follow-up. These clinical dividends invite further study of combined stress management and exercise training in angina pectoris.     

Stress, reactivity, and immune function in healthy men.

We examined the effects of acute psychological stress on lymphocyte proliferation and circulating levels of interleukin-1 and -2. Healthy men were exposed to two viewings of a gruesome surgery film and were asked to recall details of the film twice during a 30-min period. These subjects were compared to a nonstress control group. Lymphocyte proliferation to the mitogen concanavalin A (Con A; 5 micrograms/ml) was decreased during and after exposure to the stressor when compared to the control group. This decrease was more pronounced in subjects exhibiting greater blood pressure reactivity while viewing the film than in subjects showing smaller blood pressure responses. None of the other immunological measures was significantly affected by the stressor. Cortisol was not correlated with lymphocyte responsiveness. Possible explanations for these results and implications for further research are discussed.     

Setting for exercise and concerns about body appearance of women who exercise.

The present study examined the association between the sex composition of exercise environment and concerns related to body appearance of women who exercise. A questionnaire concerning social physique anxiety, body dissatisfaction, and attitude toward women-only exercise environment was administered to 81 women who used either the women-only area or the co-ed area in a fitness club. A one-way analysis of variance indicated that those who exercised in a women-only area reported more social physique anxiety and dissatisfaction with body size and favored exercising in areas exclusively reserved for women than women who exercised primarily in co-ed areas. The women-only area served as a protective environment for those who were heavier, anxious about their body appearances, and dissatisfied about their body images. These women also preferred to exercise in an exclusively female setting compared to women who used the co-ed area.     

Stress reactivity and coping in seasonal and nonseasonal depression

Stress, stress reactivity, and coping skill use were examined in individuals with seasonal depression, nonseasonal depression, and nondepressed controls. Although participants in the two depressed groups reported using more avoidance coping strategies than controls, only participants in the seasonal depressed group reported using more season-specific coping (i.e., light-related strategies) than participants in the nonseasonal depressed and control groups. Individuals in the seasonal depressed group also reporting using acceptance coping strategies less frequently than individuals in the control group. Only participants in the nonseasonal depressed group, however, exhibited greater psychophysiological arousal in reaction to a laboratory stressor (i.e., unsolvable anagram task) when compared to participants in the seasonal and nondepressed control groups. Participants in both depressed groups reported greater impact of negative life events during the past 6 months than did controls. Similarities and differences in the two types of depression may have implications for the conceptualization and treatment of seasonal depression.     

Body fat distribution and hemodynamic stress responses in premenopausal obese women: a preliminary study.

To examine the relationship between body fat distribution and hemodynamic stress responses, cardiovascular responses to a speech task and a forehead cold pressor task were evaluated with 24 premenopausal women classified a priori as either centrally or peripherally obese. Results showed that women with central adiposity exhibited greater stress-related increases in diastolic blood pressure and total peripheral resistance, whereas women with peripheral adiposity exhibited greater stress-related increases in cardiac output. Depression, self-consciousness, hostility, and mood scores did not explain significant variance in the stress response differences between regional adiposity groups. The findings suggest that central adiposity may increase the risk of cardiovascular disease in women at least in part by enhancing vascular responses to stress.     

Acute exercise: buffering psychosocial stress responses in women.

We evaluated the experimental hypothesis that an acute bout of aerobic exercise (AE) serves as a buffer to psychosocial stress responses in low to moderate physically fit women. Forty-eight (24 White, 24 Black) 25- to 40-year-old women participated in two counterbalanced experimental conditions: an attention control and a 40-min bout of AE at 70% heart rate (HR) reserve. The attention control and AE treatments were followed by (a) 30 min of quiet rest, (b) exposure to mental and interpersonal threat, and (c) 5 min of recovery. Blood pressure (BP) and HR were monitored at baseline, during the stressors, and throughout recovery. Self-reported distress was assessed before each stressor and upon completion of the recovery period. The results provided clear evidence that exercise dampens BP reactivity to psychosocial stress. Additionally, compared with the attention placebo control, AE reduced both the frequency and intensity of anxiety-related thoughts that occur in anticipation of interpersonal threat and challenge.     

Physiologic reactivity to startling tones in women with posttraumatic stress disorder.

Autonomic and eyeblink reactivity to startling tones were investigated in women with histories of childhood sexual abuse (CSA). Twenty-one women with current posttraumatic stress disorder (PTSD), 23 with lifetime but not current PTSD, and 13 women who never had PTSD listened to 15 95-dB, 500-ms, 1000-Hz tones with a 0-ms rise time while heart rate (HR), skin conductance (SC), and orbicularis oculi electromyogram (EMG) responses were measured. Participants in the current and lifetime PTSD groups produced larger HR responses across tones and showed slower absolute habituation of SC response magnitude compared with the never PTSD group. EMG response magnitudes did not differ among groups. Women with CSA-related PTSD showed increased autonomic reactivity and slower habituation to high-intensity tones similar to that observed in primarily male, combat PTSD samples. This suggests that heightened autonomic responsivity to startling stimuli in PTSD is not gender or event specific.     

Enhancing self-efficacy and exercise readiness in pregnant women

ObjectivesDespite the benefits associated with exercise during pregnancy, many expectant mothers are inactive.DesignThe present study examined whether persuasive messages could influence task and scheduling self-efficacy, exercise intention, action plans, and behavioral commitment among pregnant women.MethodsAfter completing premanipulation task and scheduling self-efficacy and exercise intention measures, participants (n = 125) were randomly assigned to read one of four efficacy-enhancing messages: scheduling, task, combined scheduling/task, or control. Postmanipulation task and scheduling self-efficacy, intentions and action plans and behavioral commitment were then assessed.ResultsRepeated-measures ANOVAs revealed that compared to the control group, inactive participants who read the persuasive messages reported significant increases in scheduling self-efficacy, task self-efficacy, and intention from premanipulation to postmanipulation as well significantly stronger action plans.ConclusionsWritten persuasive messages may promote exercise behavior during pregnancy by increasing scheduling and task self-efficacy, intention, and action plans for exercise.     

Anger and denial as predictors of cardiovascular reactivity in women

The relationship between behavioral and physiological reactivity and cardiovascular disease has been extensively researched in men, indicating that the expression of anger may be a contributory factor in the development of coronary heart disease. Few studies, however, have focused on women. Among these, women generally have been found to be less reactive to laboratory tasks than men. In the present study, 45 women aged 19–21 years were selected to represent three groups—(1) low anger/low denial, (2) high anger/low denial, and (3) low anger/high denial—based on their scores on the State-Trait Anger Expression Inventory and the Marlowe-Crowne Social Desirability Scale. Subjects received three conditions: (1) no feedback, (2) error feedback without observer present, and (3) error feedback with observer present. As hypothesized, women who reported a high level of denial and low anger exhibited elevated stress-related reactivity. The results are suggestive of a subgroup of highly reactive women not previously identified within the literature. The hypothesis that all groups would display greater reactivity in a condition providing error feedback with observation was not supported.This study was supported by a research grant to Carol S. Emerson from the Women's Research Institute of Virginia.     

Stress reactivity in social anxiety disorder with and without comorbid depression

Previous research on neuroendocrine responding to a psychological stressor in individuals with Social Anxiety Disorder (SAD) has provided inconsistent results. A recent meta-analysis concluded that Major Depressive Disorder (MDD), which is frequently comorbid with SAD, is associated with blunted stress reactivity. It is, thus, possible that comorbidity status contributes to the inconsistent findings in the SAD literature. In this study, salivary cortisol responses to a psychological stressor were examined in three groups: healthy controls (CTL), SAD, and SAD with comorbid MDD (COM). The SAD group differed from the other two groups in their cortisol stress reactivity. It is important to note that analyses combining participants with SAD with and without comorbid MDD obscured findings of cortisol reactivity. In addition, the differences in cortisol reactivity cannot be accounted for by participants' affective responses to the stressor. The current findings indicate that individuals with SAD exhibit distinct stress-related cortisol responses depending on their comorbidity statuses.     

Hostility,oral contraceptive use,and cardiovascular reactivity in women

Abstract

Hostility, task instructions, social desirability and cardiovascular reactivity were investigated in a exploratory study of 70 female college students and employees. Women were administered the Videotaped Clinical Interview (VC1), the Marlowe-Crowne Social Desirability Scale (MC), the Cook-Medley Hostility Scale (CM), the Buss-Durkee Hostility Index (BD) and the Personal Attributes Questionnaire (PAQ) before undergoing a stressful discussion. Oral contraceptive users had significantly higher DBP at baseline. Based on PAQ scores, women were given instructions for the discussion task consistent or inconsistent with their gender-relevant styles. Instruction type predicted heart rate changes, and interacted with hostility to predict DBP reactivity. Interview-based hostility (VCI-H) was associated with increased DBP during the discussion task, as was being high hostile (low MC/high VCI-H). The CM and the BD had less association with heart rate and blood pressure changes. Oral contraceptive (OC) use was associated with higher SBP reactivity under stress, with highest SBP increases in the OC users concerned with social desirability. The complex interaction between trait dimensions like hostility, social desirability, and oral contraceptive use requires further investigation.     

Stress reactivity and perception of pain among tension headache sufferers

Twenty-one tension headache sufferers and 21 control subjects were exposed to a series of psychological stressors and an ischemic pain task, involving a tourniquet around the arm. Compared to control subjects, headache patients showed higher heart rates and evidence of more prolonged vasoconstriction in the hands and the ear lobe. No between-group differences in EMG were found, however. Headache patients rated the tourniquet as more painful than did control subjects, and described themselves as more anxious, angry, and depressed. The pattern of results is consistent with the interpretation that headache patients are emotionally and autonomically hyperreactive to pain and to psychological stress.     

Physical fitness and self-reported physical exercise among college men and women in 1987 and 1997.

The study examined the relations of self-reported physical activity levels and physical fitness scores for two samples of college students assessed in 1987 (n = 261) and in 1997 (n = 243). Significantly greater exercise was reported by the 1997 women than the 1987 women; amount of exercise reported by men did not differ. For both samples, greater exercise was associated with increased fitness for women and men as assessed by the Hall 1986 Physical Fitness Test Profile, comprised of measures on body fat composition; grip strength; muscle endurance, flexibility, resting heart rate; systolic and diastolic blood pressures; and aerobic power. For the 1987 sample men were more fit than women. For the 1997 sample, women were more fit than men. The 1997 women were more fit than the 1987 women; there was no difference on overall fitness measures of the two samples of men.     

Predictors of exercise program participation in older women

Abstract

This study examined predictors of exercise program participation in females aged 60 to 89 years of age. Fifty-five exercise program participants and 50 non-exercising subjects were assessed on potential group predictor variables. Univariate analyses indicated that the Exercise compared to the Non-Exercise group had a stronger belief that they did not receive enough exercise in their everyday lives and in the health value of exercise, greater self-efficacy and enjoyment of exercise, and less physical discomfort associated with exercise. The Exercise group perceived exercise programs to be more available and greater family support to participate. Medical advice to exercise and exercise history did not differ significantly between groups. A logistic regression analysis indicated that of the variables assessed, belief that one is not receiving enough exercise in daily life and exercise availability were the most powerful predictors of exercise group membership. The implications of these findings for the promotion of exercise in older women are discussed.     

Stress, depressive symptoms, and smoking cessation among pregnant women.

Perceived stress and depressive symptoms were examined as correlates and predictors of smoking cessation during pregnancy in a sample of 819 pregnant smokers (454 baseline smokers and 365 baseline quitters). Women who quit early in pregnancy had lower levels of stress and depressive symptoms than baseline smokers. Adjusting for level of addiction and other demographic factors related to stress and depressive symptoms eliminated the significant association between depressive symptoms and smoking cessation. Lower levels of stress and depressive symptoms were not predictive of cessation in later pregnancy. Prenatal healthcare providers should continue to assess level of addiction and provide targeted intensive cessation interventions. Interventions that reduce stress and depression may also be of benefit to women who are continuing smokers in early pregnancy.     

Expectancy-value constructs and expectancy violation as predictors of exercise adherence in previously sedentary women.

This prospective study examined effects of expectancy of exercise benefits, value of benefits, expectancy violation, and self-efficacy (SE) on exercise behavior and study dropout in sedentary women (n=86). SE predicted exercise for study completers but did not predict study dropout. After 6 and 12 weeks, participants evidenced expectancy violations, particularly for fitness and weight. Initial value, expectancy, and Expectancy X Value did not predict exercise for study completers, but dropouts had higher initial positive expectancies than did completers. Expectancy violations produced in Weeks 1-6 did not predict exercise in Weeks 7-12 in study completers, but dropouts in Weeks 7-12 had higher expectancy violations for weight in Weeks 1-6 than did completers. Follow-up revealed that study dropouts stopped exercising. Identifying individuals with high initial expectancies and expectancy violations may improve health behavior intervention and research.     

Randomized Face-to-face vs. Home exercise interventions in pregnant women with gestational diabetes

ObjectivesEvaluate effects of a theoretically-based, semi-intensive (Face-to-Face; F2F) exercise intervention and minimum-contact (Home) exercise intervention to the standard care (Control) on exercise, its motivational determinants, blood glucose levels, and insulin use of pregnant women with gestational diabetes mellitus (GDM).DesignRandomized control trial with two intervention arms and control (standard care).MethodParticipants (N = 65) were randomized to a Control (standard prenatal care/GDM dietary counseling), Home (standard care + phone education/support + home exercise), or F2F (standard care + on-site education/support + guided exercise with instructor on 2 days/week) group from ∼20 weeks gestation to delivery. Assessments of exercise and motivational determinants were obtained at baseline (20-weeks gestation) and follow-up (32-weeks gestation). Blood glucose levels (fasting/postprandial mg/dL) and insulin use were extrapolated from medical records.ResultsAt the 32-week follow-up, the F2F group had significantly higher exercise min, pedometer steps/day, and motivational determinants (attitude, subjective norm, perceived control, intention) than controls (p's < 0.05) and significantly higher exercise min and subjective norm than the Home group (p's < 0.05); these effect sizes were medium-large (η² = 0.11-0.23). There was a medium effect (η² = 0.13) on postprandial blood glucose at 36-weeks gestation with the F2F group having lower values than controls. Although not significant, the F2F group started insulin later (33 weeks gestation) than the Home (27 weeks) and Control (31 weeks) groups.ConclusionA theoretically-based, F2F exercise intervention has multiple health benefits and may be the necessary approach for promoting exercise motivation and behavior among GDM women.